ACUTE ABDOMEN • SENIOR RESIDENT / SURGEON

Enterocutaneous Fistula

The first operation for an enterocutaneous fistula is often not an operation at all: stabilize, control sepsis and effluent, protect skin, define anatomy and rebuild nutrition before definitive reconstruction.

PROTOTYPE REVIEW REQUIRED

The Call

56-year-old woman, postoperative day eight after bowel surgery

Prolonged ileus and fever followed by wound erythema and enteric drainage of 750 mL/day. CT shows a jejunocutaneous fistula without distal obstruction.

Initially stable after resuscitation

High-output fistula threatens volume status, electrolytes, nutrition and skin while occult sepsis must be excluded.

Read the Image • Clinical Data

Wound / CT / Fistulogram The key visual question is not merely where the skin opening is, but where the tract originates and whether abscess or obstruction persists. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

Enterocutaneous Fistula

56-year-old woman, postoperative day eight after bowel surgery

A postoperative patient develops a high-output enterocutaneous fistula with fever, electrolyte losses and a CT collection. What is the first priority?

After months of optimization the patient is nutritionally replete, sepsis-free and anatomy is defined. The fistula persists. Best principle?

During optimization the fistula output suddenly rises and the patient becomes tachycardic with abdominal pain. Best next step?

Enter a quiet abdomen, eliminate the cause, and reconstruct healthy bowel.

Nutrition and wound care remain part of fistula surgery.

Surgical Pearls

Pitfalls

Which finding most strongly argues against spontaneous closure?